Suture locking device and methods

ABSTRACT

The present invention relates to devices and methods for securing a pair of suture lengths together or for using a single strand of suture to secure tissue(s) together at an operative site in a patient without necessarily tying a knot. The suture lock device may include a suturing securing device having an outer body member having a lumen extending therethrough, the lumen defining a suture path through the outer body, an inner wedge member axially insertable into the outer body member to secure a portion of a suture between the wedge and the interior surface of the lock member, an outer tube carrying the outer body member at the distal end of the outer tube, the outer tube carrying the wedge proximal to the outer body member, and a pusher member slidable within the outer tube to push the wedge into the lock member.

PRIORITY CLAIM

The present application claims priority to the following U.S.Provisional Patent applications having Ser. No. 60/502,925 filed Sep.15, 2003 the entirety of which is herein incorporated by reference.

FIELD OF THE INVENTION

The present invention relates to devices and methods for securing a pairof suture lengths together or for using a single strand of suture tosecure tissue(s) together at an operative site in a patient withoutnecessarily tying a knot.

BACKGROUND

Sutures are used to sew tissue together, and thereby close tissueopenings, cuts or incisions during or after any of a very wide varietyof medical procedures. Additionally sutures may be utilized to correctpatent foramen ovales (PFO) which are openings between the two atria ofthe heart. Typically, the surgeon manually ties together a suture pairto close the opening. A variety of automatic suture tying systems andsuture securing mechanisms have been developed.

Manually tying sutures together to secure tissue can be very difficultand challenging. For example, manual knot tying requires considerabledexterity in the context of a medical procedure where the surgeon'shands are gloved or when the suturing is being performed in a part of apatient's anatomy that is particularly difficult to access. Also, inminimally invasive surgical procedures or in the case of closure of apuncture in a femoral artery after a catheterization procedure, thespace adjacent the wound or tissue opening to be sutured is limited byother parts of the patient's anatomy and in many instances the openingto be closed cannot be visualized, therefore the knot must be formedblindly.

Also, manual knot tying can be time consuming as well as difficult ininstances where the tying process cannot be visualized. Knot tying isfurther complicated by the fact that surgical sutures generally have lowfriction surfaces. Therefore, it is typically necessary for a surgeon toinclude many loops or “throws” when tying a knot. Multiple throws areoften required even if an automatic knot tying device is used such asthat disclosed in U.S. Pat. No. 6,171,317 the entirety of which ishereby incorporated by reference. Unfortunately, as the number of loopsor “throws” incorporated into the knot increases, the knot becomesincreasingly large and bulky. Manually tied knots also can become“locked” prior to reaching the intended amount of tension to be appliedto the tissue. If the knot becomes “locked” prior to final deployment,the surgeon may be required to remove the suture and place a new sutureif possible or resort to other closure methods such as compression ifthe suture was being utilized to close an opening in a vessel.

Moreover, the surgeon typically needs to handle suture strands havingadequate length prior to commencing manual knot tying. Thus, manual knottying requires considerable space both in which to view, and to perform,the actual knot tying. Therefore, knot tying is particularly difficultin areas of limited available space or access, for example, at the backof the patient's heart during a coronary artery bypass graft (CABG)operation or in a tissue tract resulting from a percutaneoustransluminal catheterization procedure.

In addition to those problems described above, many of the suturesutilized for surgical procedures can only be manipulated to a certaindegree before failure. For example, when tightening a knot, the sutureis placed in tension by the surgeon, too much tension applied to thesuture may cause the suture to break. Alternatively, too much tensionapplied to the suture may cause the suture to be torn from the tissuefurther complicating closure by creating a larger wound or opening inthe tissue which then must be addressed.

Many knot replacement technologies for use with sutures have beenproposed over the years, one example of a knot replacement technology isa deformable clip. Wherein the suture ends are disposed through adeformable member which is then deformed thereby trapping the suturetherein. A shortcoming of this design is that the deformable member mustbe made to be sufficiently deformable but yet have enough strength toretain the suture therein. Further still, there is the possibility ofthe suture slipping from the deformed clip if the clip was not deformedsufficiently. Lastly, many of these deformable clips are constructed ofnon-absorbable materials and therefore remain implanted within thepatient after use, which may lead to other complications such asinfection or irritation of the surrounding tissue.

Another example of knot replacement technology is the use of a tortuouspath, wherein the suture is disposed upon or within a device thatcontains a tortuous path, wherein friction between the suture and thedevice is utilized to retain the suture. A potential shortcoming of suchdevices is that since the suture is not physically retained within thedevice there is the potential for the suture to slip or loosen from thedevice. Additionally, many of these devices require a great amount ofoperator skill or time to dispose the suture therethrough, therebyadding to the complexity of a potentially already complex surgicalprocedure.

Therefore, for the above reasons, it would be desirable to provideimproved devices, systems, and methods for securing at least one lengthof suture that has been used to suture tissue together to close anopening formed in the tissue such as a vascular puncture. It would beparticularly beneficial if these improved devices provided some or allof the benefits while overcoming one or more of the disadvantagesdiscussed above.

It is an object of the present invention to provide methods and devicesthat may be utilized in place of forming a knot in a suture to effect aclosure of the suture.

It is a further object of the present invention to provide a knotreplacement device that reduces surgical time by eliminating the need toform a knot during a surgical procedure.

It is yet another object of the present invention to provide a knotreplacement device with is biocompatible and absorbable, therebyreducing the amount of foreign material remaining implanted within apatient after a surgical procedure.

These and other objects of the present invention will be apparent fromthe following detailed description and the claims.

SUMMARY OF THE INVENTION

The present invention provides methods and apparatuses that may beutilized to secure at least one end of a suture and retain the suture.The device according to the present invention includes an outer body andan inner wedge member, wherein the outer body includes an opening formedtherein, the opening configured to receive at least one suturetherethrough. The opening further being sized and configured to receivethe inner wedge member therein, whereby the suture and the inner wedgemember are frictionally retained within the opening.

In accordance with the present invention there is provided a suture lockdevice, the suture lock device including an outer body member having alumen extending therethrough, the lumen defining a suture path throughthe outer body, an inner wedge member axially insertable into the outerbody member to secure a portion of a suture between the wedge and theinterior surface of the lock member, an outer tube having a proximal endand a distal end, the outer tube carrying the outer body member at thedistal end of the outer tube, the outer tube carrying the wedge proximalto the outer body member, and a pusher member slidable within the outertube to push the wedge into the lock member.

In accordance with the present invention there is provided a method ofsecuring and trimming a suture, the method comprising: providing asuturing locking device comprising an outer body member having anaperture disposed therethrough, the aperture defining a suture paththrough the outer body member; a wedge axially insertable into the outerbody member to secure a portion of a suture between the wedge and theinterior surface of the outer body member; an outer tube having aproximal end and a distal end, the outer tube carrying the outer bodymember at the distal end of the outer tube, the outer tube carrying thewedge proximal to the outer body member the outer tube defining a suturetail opening; and a pusher member slidable within the outer tube to pushthe wedge into the outer body member; advancing a suture through theouter body member and through the suture tail opening; pushing the wedgemember into the outer body member to secure the suture; and cutting thesuture by shearing the suture between the outer body member and an edgeof the suture tail opening.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring now to the appended drawings, wherein like numerals areutilized to denote similar objects.

FIG. 1 is a perspective view of an exemplary embodiment of the suturelock in accordance with the present invention.

FIG. 2 is a partial cross-sectional view of the outer body of the suturelock of FIG. 1 as shown in the present invention.

FIG. 3 is a cross-sectional view of the suture lock in accordance withthe present invention.

FIG. 4 is a cross-sectional view of the outer body wherein at least onesuture has been disposed therein and the inner wedge member has beenpartially disposed within an opening formed in the outer body.

FIG. 5 is a plan view of a delivery device and the suture lock inaccordance with the present invention.

FIG. 6 is an exploded assembly view of the delivery device in accordancewith the present invention.

FIG. 7 is a plan view of an alternative embodiment of a suture lock inaccordance with the present invention.

FIG. 8 is a cross-sectional view of the alternative embodiment of thesuture lock in accordance with the present invention.

FIG. 9 is another exemplary embodiment of another alternative embodimentof a suture lock in accordance with the present invention.

FIG. 10 is a perspective view of a vessel having an opening formedtherein and illustrating the use of the delivery device of the presentinvention with the suture lock disposed therein.

FIG. 11 is a plan view of the vessel after deployment of the suture lockdevice in accordance with the present invention to effect vesselclosure.

DETAILED DESCRIPTION

Before the present invention is described in such detail, it is to beunderstood that this invention is not limited to particular variationsset forth herein as various changes or modifications may be made to theinvention described and equivalents may be substituted without departingfrom the true spirit and scope of the invention. In addition, manymodifications may be made to adapt a particular situation, material,composition of matter, process, process act(s) or step(s) to theobjective(s), spirit or scope of the present invention. All suchmodifications are intended to be within the scope of the claims madeherein.

Methods recited herein may be carried out in any order of the recitedevents which is logically possible, as well as the recited order ofevents. Furthermore, where a range of values is provided, it isunderstood that every intervening value, between the upper and lowerlimit of that range and any other stated or intervening value in thatstated range is encompassed within the invention. Also, it iscontemplated that any optional feature of the inventive variationsdescribed may be set forth and claimed independently, or in combinationwith any one or more of the features described herein.

All existing subject matter mentioned herein (e.g., publications,patents, patent applications and hardware) is incorporated by referenceherein in its entirety except insofar as the subject matter may conflictwith that of the present invention (in which case what is present hereinshall prevail). The referenced items are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such material by virtue of prior invention.

Reference to a singular item, includes the possibility that there areplural of the same items present. More specifically, as used herein andin the appended claims, the singular forms “a,” “and,” “said” and “the”include plural referents unless the context clearly dictates otherwise.It is further noted that the claims may be drafted to exclude anyoptional element. As such, this statement is intended to serve asantecedent basis for use of such exclusive terminology as “solely,”“only” and the like in connection with the recitation of claim elements,or use of a “negative” limitation. Last, it is to be appreciated thatunless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs.

In accordance with the present invention there are provided methods andapparatuses for fixedly retaining at least one suture without having totie a knot in the suture. The devices in accordance with the presentinvention include a suture lock device and a delivery device, whereinthe delivery device is configured to retain and deliver the suture lockdevice over at least one suture. The delivery device may further includea suture cutting mechanism, whereby after delivery of the suture lockdevice the suture is severed. The suture lock device may be constructedof a biocompatible material such as plastics, composites, metals orpreferable of a bio-absorbable material.

Referring now to FIG. 1 there is shown an exemplary embodiment of asuture lock device in accordance with the present invention. The suturelock device will be initially described herein, whereby the deliverydevice will be described in detail below. The suture lock deviceincludes an outer body, the outer body including an aperture formedtherethrough, and an inner wedge member. The inner wedge member is sizedto be received within the aperture formed in the outer body.

As shown in FIG. 1, the suture lock 10 in accordance with the presentinvention comprises an outer body 20 having a proximal end 22 and adistal end 21. The outer body further includes an increased diametersection 27 disposed adjacent the distal end 21, wherein a recessedportion 25 extends from the distal end 21 and partially along the lengthof the body 20. The recessed portion 25 terminating a distance from theproximal end 22 of the body 20.

The outer body 20 further includes an aperture 30 disposed therethrough.The aperture 30 being sized and configured to receive an inner wedgemember 40, wherein the inner wedge member includes at least oneprojection 44, and preferably two projections 44 a and 44 b disposedbetween the distal end 41 and the proximal end 42 of the inner wedgemember 40.

The outer body 20 and the inner wedge member 40 will preferably beconstructed of the same or similar materials. Examples of suitablematerials for construction of the outer body 20 and the inner wedge 40include plastics, composites, metals and ceramics. In a preferredembodiment the outer body and the wedge are constructed of abiocompatible material and more preferably of a biocompatible materialthat is also bio-absorbable. In a preferred embodiment, the outer body20 is generally cylindrical in shape, though it is contemplated that theouter body 20 may be formed having other geometric shapes orconfigurations.

Referring now to FIG. 2, there is shown a partial cross-sectional viewof the outer body 20 in accordance with the present invention. As shownin FIG. 2, and as previously described, the outer body 20 includes anaperture 30 formed therethrough, wherein the aperture 30 is generallydisposed along an axis extending through the outer body 20. The aperture30 includes an upper portion 35 and a lower portion 38, wherein each ofthe portions are generally formed having a specific shape. As shown, theupper portion 35 is preferably formed in the shape of an inverted coneor funnel, wherein the opening has a larger diameter adjacent to itsproximal end 36 and a smaller opening adjacent the distal end 37. Asdescribed above, the aperture 30 is constructed having two portions 35and 38, wherein the lower portion 38 is preferably formed in the shapeof a cone or funnel and has a larger opening adjacent its distal end 39and a smaller opening adjacent its proximal end 43. As shown in FIG. 2,the upper portion 35 and the lower portion 38 of the aperture 30 arealigned along an axis generally extending through the center of theouter body 20, thereby forming the aperture 30 having a proximal end 32and a distal end 33 such that the aperture 30 includes a reduceddiameter portion 34 where the upper and lower portions intersect.

Referring now to FIG. 3 there is shown a partial cross-sectional view ofthe suture lock 10 in accordance with the present invention, wherein theinner wedge member 40 is shown partially disposed within the aperture 30formed in the outer body 20. As shown in FIG. 3, the inner wedge member40 includes at least one projection and more preferably two projections44 a and 44 b, wherein, as shown, the projection is sized such that itdoes not contact the wall of the aperture 30. Thus, when the inner wedgemember 40 is disposed within the aperture 30, the projections 44 and theinner wedge member form a space 47 between the inner wedge member 40 andthe aperture 30. The inner wedge member 40 may be configured to be fullyreceived within the aperture 30 of the outer body 20 or be configuredsuch that a portion of the inner wedge member adjacent the proximal end42 extends beyond a proximal surface 22 of the outer body.

Referring now to FIG. 4 there is shown a cross-sectional view of thesuture lock 10 in accordance with the present invention wherein a loopof suture 50 has been disposed through the space 47 formed between theaperture 30 of the outer body 20 and the inner wedge member 40. As shownin FIG. 4, the suture 50 is in communication with the wedge 40 and thewall of the aperture 30 and wherein projections 44 engage a surface ofthe suture 50. The space 47 is sized and dimensioned so that thefrictional forces between the suture and the components described aboveprovide a sufficient amount of force to retain the suture and the innerwedge member within the aperture 30. As shown in FIG. 4, the inner wedgemember is not fully disposed within the aperture 30. In use, the innerwedge member 40 would be advanced into the aperture 30 of the outer body20 until the projections 44 a and 44 b are sufficiently contained withinthe aperture 30 of the outer body. It is further contemplated that theinner wedge member may be configured to extend beyond the proximal endof the outer body member 20 when disposed in a final position.

Referring now to FIG. 5 of the present invention there is shown anexemplary embodiment of a delivery device in accordance with the presentinvention. The delivery device includes a handle member including atrigger and an elongated shaft portion, wherein the elongated shaftportion is configured to engage and deploy the suture lock in accordancewith methods of the present invention.

As shown in FIG. 5, the delivery device 100 includes a handle member 110having a trigger 120 and an elongate tube member 140 extending from adistal end of the handle member 110.

Referring now to FIG. 6, there is shown an exploded view of the deliverydevice 100 in accordance with the present invention wherein only oneside of the handle member 110 is shown. In accordance with the presentinvention, the delivery device includes a handle member 110 and anelongated tubular member 140. The handle member 110 is configured tohouse a trigger member 120 and a pusher member 155, wherein the triggermember 120 is configured to be in communication with a proximal portionof a pusher member 155. The pusher member being configured to beslidably disposed within the elongated tubular member 140.

Referring now to the trigger member, the trigger member 120 has a distalend 121 and a proximal end 122, wherein the proximal end includes aplurality of projections 123, whereby the plurality of projections forma gear member 124. The trigger member 120 further includes a biasingmember 127, the biasing member is configured to be in communication witha portion of the trigger member 120 and the handle member 110.

Referring now to the pusher member, the pusher member 155 includes adistal end 157 and a proximal end 158, wherein the proximal end includesa plurality of projections formed therein, wherein the projections forma gear member 159. The gear member 159 of the pusher member 155 isconfigured to engage the gear member 124 of the trigger member. Wherein,movement of the trigger member 120 will be translated to the pushermember 155 through the interaction of the gear members. The distal end157 of the pusher member 155 is configured to engage and detachablyretain the inner wedge member 40. Further still, the pusher member 155includes at least one cutting member 156 disposed adjacent the distalend 157 thereof, wherein the cutting member 156 will be furtherdescribed below in connection with methods according to the presentinvention.

Referring now to the elongated tubular member 140, wherein the elongatedtubular member 140 has a proximal end 142 and a distal end 143 with abore 141 extending therebetween. The bore 141 is configured to slidablyreceive the pusher member 155 as described above. As shown in FIG. 6, ahub 144 may be disposed at or about the proximal end of the elongatedtubular member 140, wherein the hub is configured to engage the twohalves of the handle member 10 thereby retaining the two halves of thehandle members. The distal end of the tubular member 140 will bedescribed in greater detail below with reference to FIG. 7.

Referring now to the distal end 143 of the tubular member 140. Thedistal end 143 of the tubular member 140 further includes at least onetab 146 formed therein, whereby the tab is formed in the wall of thetubular member adjacent to the distal end, such that a portion of thetab may be configured to extend into the bore 141 of the tubular member140. The tab 146 of the tubular body 140 is configured to engage therecessed portion 25 of the outer body 20 as will be described in greaterdetail below with regard to the methods according to the presentinvention. The tubular member 140 further includes a suture tail opening147 disposed adjacent to the distal end 143, wherein the suture tailopening 147 is configured and sized to receive a suture therethrough.

In addition to that described above, the tubular body 140 additionallyincludes at least one and more preferably two wedge retention tabs. Thewedge retention tabs are formed in the wall of the tubular body adjacentto the distal end 143 thereof. The wedge retention tabs are configuredto detachably retain the inner wedge member in a position adjacent tothe proximal end 22 of the outer body 20 and adjacent to the suture tailopening 147. The function of the wedge retaining tabs will be describedin more detail below with regard to the methods of use of the presentinvention.

Referring now to FIG. 7, there is shown an exemplary embodiment of analternative embodiment of a suture lock in accordance with the presentinvention, wherein like numerals have been utilized to denote similarcomponents.

As shown in FIG. 7, the suture lock 200 in accordance with thealternative embodiment includes an outer body 220 having a proximal end222 and a distal end 221 and an aperture 230 formed therethrough. Thesuture lock 200 further includes an inner wedge member 240, wherein theinner wedge member is sized and configured to be received within theaperture 230 of the outer body 220. As shown in FIG. 7, the inner wedgemember includes a projection 244 formed on one side thereof and analignment member 245 disposed on the other side thereof. Suture lock 200is configured to be used in conjunction with a single suture tail aswill be described below with reference to FIG. 8.

Referring now to FIG. 8, there is shown the suture lock 200 inaccordance with the present invention wherein a suture 5 has beendisposed through the aperture 230 of the suture lock 200. As shown inFIG. 8, the suture 5 is configured such that the suture only includes asingle suture tail, wherein the suture includes a pre-formed loop 6formed therein. The pre-formed loop may be formed by tying a knot in thesuture using known knot tying methods, or the loop may be formed in thesuture during manufacture of the suture. For example, the loop maybeformed using molding, extrusion or heat forming. As shown in FIG. 8, thesuture tail 8 is passed through the loop 6 and then passed through theaperture 230 of the suture lock, wherein the inner wedge member 240 isdisposed within the lumen, such that the suture is frictionally retainedbetween the wall of the aperture and the inner wedge member. It iscontemplated that the suture loop may be formed with a sliding knot 7,wherein the sliding knot allows the loop to close down on the suturepassed through the loop, thereby locking the suture and the looptogether.

In yet another alternative embodiment as shown in FIG. 9, it iscontemplated that one end of the suture 5 may be overmolded with theouter body 20 as shown, thereby eliminating the need for a suture loopas previously described. By overmolding one end of the suture within theouter body of the suture lock, one end of the suture is fixedly retainedwithin the outer body, thereby eliminating the need for a pre-formedsuture loop. Further still, in use, the other end of the suture does notneed to be passed through a pre-formed loop before being disposedthrough the patient's tissue adjacent the opening to be closed, therebysimplifying the closure process.

Methods of Use

The device according to the present invention will now be described inuse, the description of the methods below should be considered exemplaryin nature and should not be considered limiting in any manner.

Referring now to FIG. 10, there is shown a cross-sectional view of apatient's vessel, wherein a suture has been placed across the opening inthe vessel wall using a device such as that disclosed in U.S. Pat. No.6,136,010, the entirety of which is herein incorporated by reference.After placing the suture across the opening, the ends of the suture aredrawn through the outer body 20 of the suture lock 10 with the use of asuture snare 11 as shown in FIG. 10, thereby passing the suture endsthrough the aperture 30 of the outer body and wherein the ends of thesuture extend through the suture tail openings 147 formed in theelongated tubular member 140.

After the suture ends have been disposed through the suture lock 10 andthe elongated tubular member, the operator utilizes the handle of thedelivery device 100 to place the distal end of the suture lock adjacentto the opening formed in the vessel as shown in FIG. 11. In addition toplacing the distal end of the suture lock adjacent to the vesselsurface, the user applies tension to the suture ends. Once the suturelock 10 is placed in a desired position, and sufficient tension isapplied to the suture ends, the operator then actuates the trigger 120of the delivery device.

Upon actuation of the trigger 120, the pusher member engages the innerwedge member 40 and advances the inner wedge member 40 into the aperture30 of the outer body 20, wherein the inner wedge member is released fromthe wedge retention tabs by the pusher member 155. The pusher member 155drives the inner wedge member 40 into the aperture 30. The projections44 a and 44 b engage the suture wherein the suture frictionally engagesthe inner wall member of the aperture 30 adjacent to the inner wedgemember 40. Once the inner wedge member 40 has been disposed within theaperture 30, the pusher member 155 continues to advance thereby applyinga force to the inner wedge member, such that the force applied to theinner wedge member is greater than the retention force applied by thetabs 146 to the outer body member 20, thereby expelling the suture lock10 from the distal end of the delivery device 100. Additionally, thesuture ends which have been disposed through the suture tail openings147 are severed by the distal movement of the pusher member 155.

Once the suture lock 10 has been expelled from the delivery device 100,the delivery device can then be removed from the tissue tract of thepatient. The suture and the suture lock 10 remain within the vessel andadjacent to the vessel to close the opening formed in the vessel wall.

It is contemplated that the delivery device 100 may include a lumenextending from the handle to the distal end of the device, wherein thelumen may be configured to deliver a beneficial agent adjacent to theopening in the vessel wall, or at any location within the tissue tract.It is further contemplated that the suture lock 10 in accordance withthe present invention may be deployed through a sheath or other medicaldevice which may be deployed within the tissue tract

Although the present invention has been described for use with a suturehaving two suture ends it is contemplated according to the alternativeembodiments of the present invention that the suture lock may beintegrally formed with one end of the suture or be used with a suturehaving a pre-formed loop, wherein the free suture end would be passedthrough the suture loop, through the vessel wall, across the opening andback through the tissue wall, whereby the free end of the suture wouldthen be passed through the aperture of the suture lock. It is furthercontemplated that the suture lock may be integrally formed with a suturedelivery device such as that shown and described in U.S. Pat. No.6,136,010, wherein the device of the '010 patent would deliver a sutureacross an opening and deploy the suture lock to close the opening in thetissue.

Although the present invention has been shown and described as beingutilized to close an opening formed in a vessel wall, it is contemplatedthat the suture lock may be utilized to close other openings in tissue,such as PFOs.

It is further contemplated that the suture and the suture lock inaccordance with the present invention may be constructed of abio-absorbable material, thus, at a time after the surgical procedure noforeign material would remain within the patient's body.

Although the present invention has been described in connection with thepreferred form of the device and methods of practicing it andmodifications thereto, those of ordinary skill in the art willunderstand that many other modifications can be made thereto within thescope of the claims that follow. Accordingly, it is not intended thatthe scope of the invention in any way be limited by the abovedescription, but instead be determined entirely by reference to theclaims that follow.

1. A suture securing device comprising: an outer body member having alumen extending therethrough between a proximal end and a spaced apartdistal end, the lumen defining a suture path through the outer bodymember, the outer body member comprising at least one recessed portionon an exterior surface of the outer body member at the distal endthereof, a peripheral distal end of the outer body member comprising aproximally facing ledge; a substantially planar inner wedge memberaxially insertable into the proximal end of the outer body member tosecure a portion of a suture between the substantially planar innerwedge member and an interior surface of the outer body member, thesubstantially planar inner wedge member including at least oneprojection formed thereon, the substantially planar inner wedge member,including the at least one projection, being sized and shaped to bereceived within the lumen and not contact an inner wall of the lumendistal the proximal end of the outer body member; an outer tube having aproximal end and a distal end, the outer body member being removablydisposed within the distal end of the outer tube, a proximal portion ofthe substantially planar inner wedge member being removably disposedwithin the outer tube proximal to the outer body member; and a pushermember slidably disposed within the outer tube to push the substantiallyplanar inner wedge member into the outer body member.
 2. The suturesecuring device of claim 1, wherein the outer tube defines at least onesuture tail opening proximal to the distal end of the outer tube.
 3. Thesuture securing device of claim 2, wherein the pusher member has asuture cutter positioned to slide past the suture tail opening of theouter tube such that a suture tail extending through the suture tailopening will be cut upon the pusher member being moved distally withrespect to the outer tube.
 4. The suture securing device of claim 3,wherein the pusher member pushes the outer body member out the distalend of the outer tube after pushing the substantially planar inner wedgemember into the outer body member.
 5. The suture securing device ofclaim 2, wherein the at least one recessed portion of the exteriorsurface of the outer body member defines a distally facing ledge,wherein the outer tube defines a proximally facing tab positioned distalto the distally facing ledge when the outer body member is disposedwithin the outer tube, the tab being bent inward to cooperate with thedistally facing ledge to detachably retain the outer body member in theouter tube.
 6. The suture securing device of claim 5, wherein the pushermember pushes the substantially planar inner wedge member and outer bodymember with sufficient force to move the outer body member past theproximally facing tab to eject the outer body member from the outertube.
 7. The suture securing device of claim 1, wherein the outer bodymember and the substantially planar inner wedge member are constructedof a bio-compatible material.
 8. The suture securing device of claim 7,wherein the bio-compatible material is bio-absorbable.
 9. The suturesecuring device of claim 1, further the lumen comprising an apertureformed in the outer body member, the aperture being configured toreceive at least one suture therethrough.
 10. The suture securing deviceof claim 1, wherein the at least one projection formed thereon isdisposed adjacent a proximal end of the substantially planar inner wedgemember.
 11. The suture securing device of claim 1, wherein the outerbody member is generally cylindrically shaped with a diameter at thedistal end being greater than a diameter at the proximal end.
 12. Thesuture securing device of claim 1, wherein the proximally facing ledgesubstantially encircles the outer body member.
 13. The suture securingdevice of claim 1, wherein the lumen has an hourglass shape.
 14. Thesuture securing device of claim 1, wherein the interior surface of theouter body member is substantially smooth between the proximal end andthe distal end.
 15. A method of securing and cutting a suture, themethod comprising: providing a suture locking device comprising an outerbody member having an aperture disposed therethrough between a proximalend and a spaced apart distal end, the aperture defining a suture paththrough the outer body member, the outer body member comprising at leastone recessed portion on an exterior surface of the outer body member atthe distal end thereof, a peripheral distal end of the outer body membercomprising a proximally facing ledge; a substantially planar inner wedgemember axially insertable into the proximal end of the outer body memberto secure a portion of a suture between the substantially planar innerwedge member and an interior surface of the outer body member, thesubstantially planar inner wedge member comprising at least oneprojection formed thereon; an outer tube having a proximal end and adistal end, the outer body member being removably disposed within thedistal end of the outer tube, a proximal portion of the substantiallyplanar inner wedge member being removably disposed within the outer tubeproximal to the outer body member, the outer tube defining a suture tailopening; and a pusher member slidably disposed within the outer tube topush the substantially planar inner wedge member into the outer bodymember, the pusher member having at least one cutting member adjacent toa distal end thereof; advancing a suture through the outer body memberand through the suture tail opening; by the pusher member, pushing thesubstantially planar inner wedge member distally into the outer bodymember to secure the suture, the substantially planar inner wedgemember, including the at least one projection being sized and shaped tobe received within the aperture and not contact an inner wall of theaperture distal the proximal end of the outer body member; and cuttingthe suture with the cutting member by shearing the suture between theouter body member and an inside edge of the suture tail opening.
 16. Themethod according to claim 15, wherein the outer body member and thesubstantially planar inner wedge member are constructed of abio-compatible material.
 17. The method according to claim 16, whereinthe bio-compatible material is bio-absorbable.
 18. The method accordingto claim 15, wherein the step of advancing a suture through the outerbody member includes using a suture snare to dispose the suture throughthe outer body member and through the suture tail opening.
 19. Themethod according to claim 15, wherein the at least one projection isconfigured to frictionally engage the suture when the substantiallyplanar inner wedge member is disposed within the aperture.
 20. A suturesecuring device comprising: an outer body member having a lumenextending therethrough between a proximal end and a spaced apart distalend, the lumen defining a suture path through the outer body member, aperipheral distal end of the outer body member comprises a proximallyfacing ledge; a substantially planar inner wedge member axiallyinsertable into the proximal end of the outer body member to secure aportion of a suture between the inner wedge member and an interiorsurface of the outer body member, the inner wedge member including atleast one projection formed thereon, the inner wedge member, includingthe at least one projection, being sized and shaped to be receivedwithin the lumen and not contact an inner wall of the lumen distal theproximal end of the outer body member; an outer tube having a proximalend and a distal end, the outer body member being removably disposedwithin the distal end of the outer tube; and a pusher member slidablydisposed within the outer tube to push the inner wedge member into theouter body member.
 21. The suture securing device of claim 20, whereinthe inner wedge member is elongate.
 22. The suture securing device ofclaim 20, wherein a proximal portion of the inner wedge member isremovably disposed within the outer tube proximal to the outer bodymember.
 23. A method of securing and cutting a suture, the methodcomprising: providing a suture locking device comprising: an outer bodymember having an aperture disposed therethrough between a proximal endand a spaced apart distal end, the aperture defining a suture paththrough the outer body member, a peripheral distal end of the outer bodymember comprises a proximally facing ledge; a substantially planar innerwedge member axially insertable into the proximal end of the outer bodymember to secure a portion of a suture between the inner wedge memberand an interior surface of the outer body member, the substantiallyplanar inner wedge member comprising at least one projection formedthereon; an outer tube having a proximal end and a distal end, the outerbody member being removably disposed within the distal end of the outertube, the outer tube defining a suture tail opening; and a pusher memberslidably disposed within the outer tube to push the inner wedge memberinto the outer body member, the pusher member having at least onecutting member adjacent to a distal end thereof; advancing a suturethrough the outer body member and through the suture tail opening; bythe pusher member, pushing the inner wedge member distally into theouter body member to secure the suture, the substantially planar innerwedge member, including the at least one projection being sized andshaped to be received within the aperture and not contact an inner wallof the aperture distal the proximal end of the outer body member; andcutting the suture with the cutting member.
 24. The method according toclaim 23, wherein cutting the suture with the cutting member comprisesshearing the suture between the outer body member and an inside edge ofthe suture tail opening.
 25. The suture securing device of claim 23,wherein the inner wedge member is elongate.
 26. The suture securingdevice of claim 23, wherein a proximal portion of the inner wedge memberis removably disposed within the outer tube proximal to the outer bodymember.